Tivoli At Divine Savior Healthcare - Portage Nursing Home
General Information
UPDATEFederal Provider Number
525518
Provider Name
TIVOLI AT DIVINE SAVIOR HEALTHCARE
Provider Address
2805 HUNTERS TRAIL
PORTAGE, WI 53901
PORTAGE, WI 53901
Provider Phone Number
6087455900
Provider SSA County
100
Provider County Name
Columbia
Ownership Type
Non profit - Church related
Number of Certified Beds
83
Number of Residents in Certified Beds
73
Provider Type
Medicare and Medicaid
Provider Resides in Hospital
Y
Legal Business Name
DIVINE SAVIOR HEALTHCARE, INC
Date First Approved to Provide Medicare and Medicaid services
1993-07-24
Continuing Care Retirement Community
N
Special Focus Facility
N
Provider Changed Ownership in Last 12 Months
N
With a Resident and Family Council
Resident
Automatic Sprinkler Systems in All Required Areas
Yes
Rating Detail Information
Overall Rating
3
Overall Rating Footnote
Health Inspection Rating
2
Health Inspection Rating Footnote
QM Rating
4
QM Rating Footnote
Staffing Rating
5
Staffing Rating Footnote
RN Staffing Rating
5
RN Staffing Rating Footnote
Reported Staffing Footnote
Physical Therapist Staffing Footnote
Reported CNA Staffing Hours per Resident per Day
3.00068
Reported LPN Staffing Hours per Resident per Day
0.39726
Reported RN Staffing Hours per Resident per Day
1.37877
Reported Licensed Staffing Hours per Resident per Day
1.77603
Reported Total Nurse Staffing Hours per Resident per Day
4.77671
Reported Physical Therapist Staffing Hours per Resident Per Day
0.17603
Expected CNA Staffing Hours per Resident per Day
2.47018
Expected LPN Staffing Hours per Resident per Day
0.66733
Expected RN Staffing Hours per Resident per Day
0.98664
Expected Total Nurse Staffing Hours per Resident per Day
4.12415
Adjusted CNA Staffing Hours per Resident per Day
2.98066
Adjusted LPN Staffing Hours per Resident per Day
0.49410
Adjusted RN Staffing Hours per Resident per Day
1.04417
Adjusted Total Nurse Staffing Hours per Resident per Day
4.66871
Cycle 1 Total Number of Health Deficiencies
4
Cycle 1 Number of Standard Health Deficiencies
4
Cycle 1 Number of Complaint Health Deficiencies
1
Cycle 1 Health Deficiency Score
16
Cycle 1 Standard Survey Health Date
2014-07-03
Cycle 1 Number of Health Revisits
1
Cycle 1 Health Revisit Score
0
Cycle 1 Total Health Score
16
Cycle 2 Total Number of Health Deficiencies
8
Cycle 2 Number of Standard Health Deficiencies
6
Cycle 2 Number of Complaint Health Deficiencies
4
Cycle 2 Health Deficiency Score
92
Cycle 2 Standard Health Survey Date
2013-04-03
Cycle 2 Number of Health Revisits
1
Cycle 2 Health Revisit Score
0
Cycle 2 Total Health Score
0
Cycle 3 Total Number of Health Deficiencies
12
Cycle 3 Number of Standard Health Deficiencies
11
Cycle 3 Number of Complaint Health Deficiencies
1
Cycle 3 Health Deficiency Score
84
Cycle 3 Standard Health Survey Date
2012-02-15
Cycle 3 Number of Health Revisits
1
Cycle 3 Health Revisit Score
0
Cycle 3 Total Health Score
84
Total Weighted Health Survey Score
52.66700
Number of Facility Reported Incidents
1
Number of Substantiated Complaints
2
Number of Fines
1
Total Amount of Fines in Dollars
9718
Number of Payment Denials
0
Total Number of Penalties
1
Location
Processing Date
2015-06-01
Nursiong Homes Nearby
Columbia Health Care Center
323 W Monroe St Po Box 895 |
WYOCENA WI 53969 | 9.4 miles away
Golden Livingcenter-wisconsin Dells
300 Race St |
WISCONSIN DELLS WI 53965 | 15.4 miles away
Good Samaritan Society-lodi
700 Clark St |
LODI WI 53555 | 17.2 miles away
Golden Livingcenter-continental Manor Of Randolph
502 S High St |
RANDOLPH WI 53956 | 23.1 miles away
Columbus Health And Rehab
825 Western Ave |
COLUMBUS WI 53925 | 27.1 miles away
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